Poison Exposures Through Breastfeeding
by Anne Eglash MD, IBCLC, FABM
The authors of this week’s article evaluated 2319 calls placed to the U.S. Poison Center from 2001-2017 related to substance exposure through breastmilk. Among these calls, 76% came from residences, 15.5% from healthcare facilities, and 0.6% from workplaces. Approximately 78% of these calls were managed at home, whereas 20% of these exposures were managed at a healthcare facility. Among those with medical intervention, 8.2% were admitted to the intensive care unit.
The most common symptoms reported to Poison Control were infant drowsiness, lethargy, agitation, irritability, vomiting, diarrhea, and rash.
Among all of the calls, there was only 1 (0.04%) death, 8 (0.3%) major health effects, and 43 (1.9%) moderate effects. Opioids and benzodiazepines were the substances most likely to be involved in the serious adverse events.
Risk factors for adverse outcomes with maternal opiate use included high maternal dose, opioid-naive child (not exposed to opiates in utero), and combination opioid and benzodiazepine exposure through breastmilk.
- Ethanol (alcohol)
See the Answer
We described calls to U.S. poison centers (PCs) related to potential exposure to substances through breast milk.
Materials and Methods
We analyzed National Poison Data System calls between 2001 and 2017 with ‘‘Exposure through breast milk’’ or ‘‘Drug use during breastfeeding’’ as the coded scenario. Data handling and descriptive statistics were carried out using SAS JMP 12.01.
U.S. PCs received 76,416 information calls and 2,319 exposure calls related to breastmilk. Exposure calls were from a residence in 76% (n = 1,758), from health care facilities (HCFs) in 15.5% (n = 360), and from a workplace in 0.6% (n = 15). A total of 466 exposures (20.1%) were subsequently managed at a HCF: 269 were evaluated and released (58%), 38 were admitted to intensive care unit (8.2%), and 53 were admitted to hospital floor (11%). Medical outcomes included 1 death (0.04%), 8 major effect (0.3%), 43 moderate effect (1.9%), 170 minor effect (7.3%), and 390 no effect (16.8%). Exposure calls that reported major effects involved opioids, benzodiazepines, ethanol, cyclobenzaprine, insulin, and amphetamines. Exposure calls most commonly involved antibiotics, antifungals, benzodiazepines, opioids, and selective serotonin reuptake inhibitors (SSRIs).
A total of 1,192 exposures (51.4%) had reported signs/symptoms including drowsiness, agitation, rash, and vomiting/diarrhea. Information calls most commonly involved systemic antibiotics, SSRIs, antihistamines, corticosteroids, and benzodiazepines.
Substances common to both exposure and information calls included antibiotics, benzodiazepines, and SSRIs. Most cases of severe toxicity included potential exposures through breast milk to benzodiazepines and opioids. These data may help inform educational outreach, risk assessment, and bedside care for breastfeeding mothers.
This report is valuable because it involves a large number of phone calls nationally, so likely a good representation of the most common infant substance effects via breastfeeding. Of note, although there were many calls regarding exposure to antidepressants, specifically SSRIs (selective serotonin reuptake inhibitors such as fluoxetine, sertraline, citalopram, etc.), these antidepressants were not responsible for the most serious infant health effects.
Cocaine and marijuana were not among the top 10 substances for which the Poison Center was contacted, likely because the other substances listed are more widely used/prescribed. Also, I wonder if families don’t call about illicit substances, for fear of involving law enforcement. Now that marijuana has become legalized in so many states, it will be interesting to see if marijuana becomes a top 10 offender in 5 years.